It’s a good question to ask when you are entering therapy. Heck, if I’m starting something new, I want to know what I’m getting into. Therefore, I want to talk about how I tend to structure therapy. I’ll be focusing on trauma therapy in this post since that is what I practice the most often, but it’s still relevant information even if trauma isn’t the issue that you are coming to therapy for.
I think of trauma therapy in three stages: safety, processing, and reconnection. This theory comes from Judith Herman’s book “Trauma and Recovery,” which has had a huge influence on how I practice.
Many people call me seeking relief from symptoms that have overwhelmed their ability to cope. It can be scary to think about spending an hour per week sitting in this suffering that is part of the problem in the first place. That’s why I focus on safety first.
Therapy is only an hour out of your week, and I want you to be able to go about the rest of your week without feeling totally overwhelmed by what we are doing in therapy. After an assessment, we will start by developing tools and strategies to increase your feelings of safety, both in and out of session. These tools are concrete things that you can do on a daily basis to help yourself in those moments where you feel overwhelmed. It might be mindfulness, distraction, self-soothing or a whole host of other things. Together, we will find what works best for you. You are probably already be doing some of these things, which is great! I want to know more about them when they work and when they don’t. By getting a clearer picture, we can boost your skills and fill in any gaps.
The second stage of processing memories can take many forms. When I say processing memories, I mean shifting memories from feeling overwhelming into memories that feel like another part of your past (aka fairly neutral). My main tools for processing memories are talk therapy and Eye Movement Desensitization and Reprocessing (EMDR). EMDR is an evidence-based method for reducing post-traumatic stress, and you can read more about it here. Together, we will decide what strategy is right for you. My main goal is to help you face what happened so it no longer crops up in your life and overwhelms you at unexpected times. Also, this phase won’t include any white-knuckling your way through memories. You get to set the pace.
What we actually do in the processing stage depends on what is most upsetting about the previous memories. I want to learn more about what keeps memories stuck in the forefront of your mind rather than fading away like many other memories. One of the key components of a traumatic memory is that it often feels like it happened yesterday. By processing it in therapy, these trauma memories usually start to feel just like any other memory: part of your past. To get to that place, you might also find that your perspective shifts. It might include more self-compassion, a greater sense of understanding, or more acceptance.
In the third stage, we will look at ways that you want to reconnect with your life while also holding onto the changes that you have made. Trauma can isolate you from yourself and from people in your life. It’s part of that safety sensor in your brain that often triggers incorrectly when you have experienced trauma. Once those memories no longer feel overwhelming, you might notice that safety sensor is less reactive. You can start to imagine what situations will look like in the future and how you will use your skills and insight to handle them without feeling overwhelmed. It’s my hope that therapy leads to you feeling a greater sense of courage to live a connected and authentic life. Reconnection is a great stage to find what it means to live your life without trauma getting in the way.
In the end, you get to decide when you are done. I will check in with our goals along the way and review the progress that you have made. But it will be up to you to decide when the changes are enough to live your life without therapy. I’m not a therapist who hangs onto clients forever, and I look forward to celebrating in the therapy successes, big and small, that help you lead a life worth living.